The health care provider has a direct impact on the satisfaction of our members and the quality of our health benefit plans. One of our stated corporate goals is "to establish and maintain long-lasting, mutually beneficial relationships with health care providers." The provider networks operated by Blue Cross and Blue Shield of Oklahoma (BCBSOK) form the foundation of this relationship.
ASO clients are employer groups who contract with Blue Cross and Blue Shield of Oklahoma for claims processing services, provider network access, clerical services or other administrative responsibilities that area part of an employer group health benefit plan.
There are six provider networks:
More than 10,000 health care providers representing a wide variety of specialties participate in the BlueTraditional network. Almost every acute care facility in the state participates in the BlueTraditional Network.
Blue Plan65 Select is a Medicare PPO network which offers eligible enrollees in select areas the Medicare supplemental benefits of standard Plan F with the cost-savings of a preferred provider organization.
The Oklahoma Caring Foundation, Inc., and its Caring Program for Children were created in 1995 by BCBSOK to provide access to preventive and primary outpatient health care services to eligible uninsured children. BCBSOK absorbs all administrative costs and matches the first $100,000 donated each year.
The success of the Caring Program for Children depends on community contributions and the participation of health care providers. Health care providers agree to provide limited benefits to program recipients for 60% of the BCBSOK BlueTraditional reimbursement rates. BlueTraditional health care providers are offered the opportunity to participate in this vital program.
BlueLincs HMO is fully licensed by the Oklahoma Insurance Department as a health maintenance organization. BlueLincs HMO is currently accredited by Utilization Review Accreditation Corporation. View the BlueLincs HMO service area map .
The BlueLincs network includes a combination of over 1,000 physicians and health care professionals and more than 30 hospitals. The network is available to members in both urban and rural areas of the state. The entire service area of this network includes 44 counties throughout the state.
Precertification/Preauthorization — Precertification/Preauthorization is required for the following classes: Non-Emergent inpatient hospital admissions at least 24 hrs prior to scheduled service, Emergency Admissions within 2 working days of the admission, all outpatient surgeries and procedures at least 24 hrs prior to scheduled service, referrals to out-of-network providers, ambulatory surgery center procedures, home care or hospice and out of area services. Please contact the BlueLincs Precertification Department to request precertification/preauthorization.
Out-of-Network — If medically necessary services are not available within the member's network, the provider should request out-of-network referral authorization from the Plan. Out-of-Network referrals are only authorized by BCBSOK if the services are a covered benefit, medically necessary and if the services are unavailable within the network. For any member, call the precertification department and request authorization for an out-of-network referral. Learn more on our Oklahoma Precertification Requirements page.
Away from Home Care — BlueCard is a national program that enables members of one Blue company to obtain healthcare services while traveling or living in another Blue company's service area. The program links participating healthcare providers with the independent Blue companies across the country and in more than 200 countries and territories worldwide, through a single electronic network for claims processing and reimbursement. BlueCard is a national program that enables members of one Blue company to obtain healthcare services while traveling or living in another Blue company's service area. The program links participating healthcare providers with the independent Blue companies across the country and in more than 200 countries and territories worldwide, through a single electronic network for claims processing and reimbursement.